Provider Demographics
NPI:1053577239
Name:WILKES PHYSICIAN NETWORK, INC.
Entity type:Organization
Organization Name:WILKES PHYSICIAN NETWORK, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRIEDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOWDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-403-4146
Mailing Address - Street 1:1915 W PARK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3511
Mailing Address - Country:US
Mailing Address - Phone:336-903-8700
Mailing Address - Fax:336-651-8196
Practice Address - Street 1:1915 W PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3511
Practice Address - Country:US
Practice Address - Phone:336-903-8700
Practice Address - Fax:336-651-8196
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILKES PHYSICIAN NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-06
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950358Medicaid
NC5950358Medicaid